Can Anxiety Issues Be the Cause of a Substance Abuse Issue?

Dual Diagnosis

One of the best definitions of anxiety comes from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which states that anxiety is based on fear, specifically the “anticipation of future threat,” with associated “muscle tension and vigilance in preparation for future danger.”³ In other words, living with anxiety means living with the fear that something unsafe is just around the corner, and your body acts accordingly.

Addiction, on the other hand, is “a chronic disease characterized by drug seeking and use that is compulsive, or difficult to control, despite harmful consequences,” according to National Institute on Drug Abuse (NIDA).¹ Other signs and symptoms of addiction include:⁴

• Impaired control.
• A strong urge to use and trouble stopping in spite of drug-related problems.
• Trouble at work or school.
• Cutting back on your social life or hobbies because of drug use.
• Using drugs in dangerous situations.
• Tolerance, or the physical need to use more of the drug to get the same effect.
• The onset of withdrawal if you try to stop.

Some people may wonder why anxiety and drug abuse appear together so often. It’s not always clear which comes first: the anxiety or the drug use.⁵ Some studies show that people who live with anxiety may turn to drugs to self-medicate, while others have proposed that drug use makes people more anxious. There are still other studies that suggest that anxiety and drug use may have similar sources: that things like genetics or flawed family circumstances can lead you to use drugs and develop anxiety.⁵

Regardless of what the answer is, anxiety and drug abuse are two of the most common psychiatric disorders. One study showed that 11.08% of Americans had an anxiety disorder and 9.35% had a substance use disorder.⁶ For someone who is overwhelmed by anxiety, using drugs can function as a way to “escape” their problems or to temporarily self-medicate and lessen the symptoms.⁷ Whatever the intention, substance abuse as a means of coping with anxiety won’t result in any lasting therapeutic benefit and can worsen the situation in the long-run.

Anxiety Symptoms

Because 28.8% of people will develop anxiety at some point in their lifetime and drug users are eager to escape their anxiety, it’s important to understand what anxiety is.⁸ However, there are several forms of anxiety, each with their own symptoms, causes, and treatment options. Three of the top anxiety disorders are generalized anxiety disorder (GAD), panic disorder, and social anxiety phobia, and each are addressed below.

Generalized Anxiety Disorder (GAD)

Symptoms of GAD include:⁹

• Feeling restless, tense, irritable, or edgy.
• Getting tired easily.
• Having difficulty concentrating or a feeling of your mind going blank.
• Muscle tension.
• Having sleep problems, including trouble falling asleep, trouble staying asleep, or experiencing restless sleep.

Generally speaking, you can be diagnosed if you have 3 or more of these symptoms for at least 6 months.⁹ About 3.1% of Americans (6.8 million adults) are affected by GAD every year.⁹ The cause of GAD is unknown, but there are several factors that may contribute to it, including your genetics, upbringing, and difficult life experiences.

There are a variety of ways to find relief from GAD, including:^10-12

• Cognitive behavioral therapy (CBT), which helps you to pinpoint untrue, unhealthy, or negative thoughts; shows you how they lead to self-destructive behavior; and teaches you how to replace those thoughts with more realistic, healthy ones.
• Learning mindfulness, which the American Psychological Association defines as “moment-to-moment awareness of one’s experience without judgment” The benefits of mindfulness include a reduction in repetitive thought, stress, and negative emotional reactions, as well as improved responses to fear.
• Acceptance Commitment Therapy (ACT), which uses 6 principles to help you deal with anxiety:
  • Acceptance, as opposed to avoiding what makes you anxious.
  • Cognitive diffusion, which help you change the way you react to anxious thoughts.
  • Being present, or mindfulness.
  • Self-as-context, or being aware of your experiences without emotional attachment.
  • Values, or determining the way you’d like to live your life without thinking about what you “should” do or what others would want you to do.
  • Committed action, which takes your personal values and attaches meaningful goals to them.

Certain medications with sedating or anti-anxiety properties may also help, including:¹³

• Selective serotonin reuptake inhibitors (SSRIs).
• Serotonin-norepinephrine reuptake inhibitors (SNRIs).
• Tricyclic antidepressants (TCAs).
• Monoamine oxidase inhibitors (MAOIs).
• Anticonvulsants.
• Beta blockers.
• Atypical antipsychotics.

Benzodiazepines may be effective in managing symptoms of GAD in the short-term. However, because these medications have abuse potential of their own, treatment in a dual diagnosis setting may avoid this option.

Panic Disorder

This anxiety disorder may be present in people who have panic attacks (also known as anxiety attacks) that come unexpectedly or seemingly out of nowhere.¹⁴ If you’re unfamiliar with an anxiety attack, some of the symptoms include:^15,16

• Heart palpitations.
• Accelerated heart rate.
• Pounding heart.
• Sweating.
• Bodily shakes or tremors.
• Feeling short of breath, like you can’t breathe, or like you’re choking.
• Chest pain or tightness.
• Nausea.
• Feeling dizzy, light-headed, or faint.
• Numbness or tingling.
• Feeling either overheated or having chills.
• Being afraid that you’re losing control, “going crazy,” or dying.
• Derealization, or feeling like you’re in a dream, like you’re disconnected from the people around you, like the world around you is blurry or too clear, or like things around you or time itself is distorted.
• Depersonalization, or feeling like you’re observing your thoughts and actions instead of experiencing them, like you’re separate from your own body or that it’s distorted, like you’re not in control of your actions, like you’re emotionally or physically numb, or like your memories aren’t your own.

Panic disorder often starts around age 20, but it can first manifest in childhood when kids experience symptoms of panic that then develop into panic disorder later in life.¹⁴ About 2-3% of Americans live with panic disorder every year; women are diagnosed with it twice as often as men.¹⁴

A diagnosis of panic disorder is made based on the following criteria:¹⁷

• Frequent panic attacks that seem to come out of the blue.
• After an attack, having a month or more of continued fear of having another attack or losing control or “going crazy.”
• Avoiding situations that you believe might trigger another anxiety attack.
• Panic attacks are not precipitated by drugs or another substance, a mental condition, or a separate mental health condition.

Like GAD, the cause of panic disorder is uncertain, but there are some factors that may contribute to it, including genetics, a history of extreme stress, or being sensitive or prone to nervousness.¹⁸ However, there are many ways to treat panic disorder or decrease its symptoms. CBT can be helpful, as can medications like SSRI and SNRI antidepressants. While benzodiazepines may be effectively used to manage acute panic episodes, they may be a less common treatment option for individuals with other substance abuse issues.

Social Anxiety Disorder or Social Phobia

According to the ADAA, social anxiety disorder is “intense anxiety or fear of being judged, negatively evaluated, or rejected in a social or performance situation.”¹⁹ As a result, you may worry about seeming anxious or awkward and avoid social situations when you can. If you can’t, you may feel extreme dread and nervousness. This can lead to a significantly compromised daily life and an increased likelihood of problems, such as failure to complete school, avoidance of job interviews, giving up jobs that require social interaction, cutting back on your social life, and avoiding romantic relationships.¹⁹

These compromises are made, in part, to avoid the onset of intense physical symptoms, like:¹⁹

• Rapid heart rate.
• Nausea.
• Sweating.
• Blushing.
• Stumbling over your words.
• Severe anxiety episodes.

More than 15 million adults in America are affected by social anxiety disorder; it’s the second most common anxiety disorder after having a phobia.¹⁹ It usually starts to manifest when you’re in your teens, but many people with social anxiety were shy as children. A study of more than 10,000 teenagers showed that 12% of those who said they were shy children also qualified for social anxiety disorder.²⁰

To diagnose social anxiety disorder, your doctor may perform a physical and discuss your symptoms, but the official criteria from the DSM-5 are:²¹

• Intense distress in social situations due to fear of being judged or humiliated.
• Avoiding social situations due to this distress or going through with them in spite of it.
• Feeling more anxiety than is proportionate to the situation.
• Having symptoms that interfere with your daily life and that aren’t explained by another medical condition.

Social anxiety disorder can be treated by many means, including:²¹

• CBT, either in groups or individually.
• Exposure therapy, or gradually working up the courage to face your fears through skills training, role-playing, and practicing for future social situations.
• Medications, such as SSRIs, SNRIs, beta blockers, or benzodiazepines. As with the other types of anxiety disorders, benzodiazepines may not be a first line of treatment when a co-occurring substance use disorder is present.

Dual Diagnosis Treatment

Understand that treatment for drug use should coincide with treatment for any of these anxiety disorders, which may include:²²

• Detoxification.
• Rehabilitation, either inpatient or outpatient.
• Substance abuse counseling.
• Medication-assisted treatment, depending on the abused substance type.
• Follow-up to avoid relapse, including intensive outpatient programs (IOPs), sober housing, and using a 12-step program, among other commonly used avenues of aftercare.

Resources

Struggling daily with both anxiety and substance abuse can be overwhelming, but there are ways to seek help:

• The ADAA has a website dedicated to help you find a therapist. They also have an infographic for day-to-day tips about how to manage anxiety, as well as an online and app-based support group for people living with anxiety.
• The Substance Abuse and Mental Health Services Administration (SAMHSA) has a Behavioral Health Treatment Services Locator.
• SAMHSA runs a National Helpline, also known as the Treatment Referral Routing Service, provides the same service by phone. You can call 24/7, every day of the year for free and confidential help: 1-800-662-HELP.
• The American Academy of Addiction Psychiatry has a database of specialists that can help you find treatment in your area.
• The National Alliance on Mental Illness (NAMI) has a helpline to assist you with any questions you might have. You can call 1-800-950-NAMI, Monday-Friday 10 a.m.-6 p.m. Eastern, or text 741-741 at any time for emergency support. They also offer peer-to-peer groups where you can gather and discuss both your anxiety and your recovery.

No matter how you decide to seek help, make sure you do. Anxiety and drug use are difficult enough to live with individually—take the steps to ensure that you don’t have to deal with both on your own.